Type 2 Diabetes Mellitus
- Diabetes Mellitus is an endocrine disorder diagnosed by chronic hyperglycemia (a fasting blood glucose > 126 mg/dl or a random blood glucose sampling > 200mg/dl
- Type 2 Diabetes Mellitus individuals are resistant to insulin on peripheral tissue
- In type 2 Diabetes Mellitus, the cell does not respond to insulin (resistant) & does not take glucose into the cell (insulin transports glucose into the cell)- think of insulin as a key that opens the door to let glucose (sugar) into the cell. In insulin resistance the key (insulin) does not work, therefore the body starts to produce less insulin
- Metabolic defects in Type 2 Diabetes are: peripheral insulin resistance in muscle and fat, decreased pancreatic insulin secretion & increased hepatic glucose output
- Risk factors for Type 2 Diabetes Mellitus are: aging, sedentary lifestyle & obesity
- Major cause of insulin resistance is obesity
- Clinical Manifestations: hyperglycemia that, if untreated, leads to: Macrovascular complications, microvascular complications, neuropathic complications, increase in LDL cholesterol levels, foot infections, poor wound healing, impotence, skin rashes, yeast infections
- Treatment: Control blood glucose levels to prevent acute & chronic complications of Diabetes.
- American Diabetes Association recommends a preprandial blood glucose level between 70-130 mg/dl & postprandial blood glucose levels less than 180 mg/dl for adults with Diabetes & HbA1c < 7%.
- Metformin is usually the first line drug for treatment of Type 2 Diabetes Mellitus and can be used as monotherapy
- Treatment also includes: Lifestyle changes- Diet, exercise, smoking cessation, daily foot care & medications.
- Treatments must be individualized for each patient
- Hyperosmolar coma is more common in Type 2 Diabetes Mellitus
- Family history (first-degree relative)
- age greater than 45 years
- Impaired fasting glucose
- Delivery of baby weighing more than 9 pounds
- Hyperlipidemia (HDL < 40 mg/dL men, <50 mg/dL women; triglycerides>250 mg/dL)
- Ethnicity: African American, Hispanic American, Native American, Asian American, Pacific Islander
Pharmacologic Agents Associated with iatrogenic hyperglycemia
- Hormonal therapies (oral contraceptives)
- Immunosuppressants (tacrolimus & cyclosporine)
- Nicotinic acid (Niacin)
- Antiviral HIV protease inhibitors
- Several atypical antipsychotic agents (clozapine & olanzapine)
- Calcium Channel blockers
- Thiazide diuretics
Clinical Signs & Symptoms
- Because the onset of diabetes usually occurs years before a diagnosis is made, patients are usually asymptomatic (Type 2 DM is usually insidious)
- Symptoms of Type I & Type II DM are basically the same
- The patient is often obese with a history of dyslipidemia, hypertension, & CAD
- Neuropathic complaints: numbness & tingling
- Increased urination, nocturia, thirst, or polydipsia
- Vaginitis (candidiasis)
- Skin infection
- Hyperosmolar hyperglycemia syndrome (HHS) is severe dehydration resulting from prolonged hyperglycemia
- HHS was formally known as hyperosmolar hyperglycemia nonketotic coma (HHNC)
- HHS is associated with a high mortality rate
- Symptoms of DM Plus random plasma glucose concentration of 200 mg/dL or higher on two occasions
- Fasting plasma glucose of 126 mg/dL or higher on two occasions. Fasting is defined as no caloric intake for at least 9 hours
- 2 hour post load glucose 200mg/dL or higher during an oral glucose tolerance test on 2 occasions. This test should be performed using a glucose load containing the equal event of 75 g of anhydrous glucose dissolved in water. This test is not recommended for a routine clinical diagnosis or in pregnancy.
- Type I DM
- genetic defects in insulin action
- diseases of the pancreas
- drug or chemical induced DM shit
- Neurologic disorders that mimic diabetic neuropathy
- Lifestyle modifications remain the initial management of type II DM (begin immediately on diagnosis of Type II DM
- Self monitoring of blood glucose
- Pharmacologic therapy when lifestyle modifications & exercise are not effective
Complications of Type II DM
- Macrovascular disease
- Psychosocial (↑stress, anxiety & guilt)
Dunphy, L.M., Winland-Brown, J. E. (2011). Primary Care: The Art and Science of
Advanced Practice Nursing. Philadelphia, PA. F.A. Davis.
Uphold, C. R., & Graham, M. V. (2013). Varicella. In Clinical guidelines in family practice (pp. 243-246).
Gainesville, Fl: Barmarrae Books, Inc.